Cost‑effectiveness analysis of indocyanine green fluorescence imaging-guided laparoscopic lymphadenectomy for gastric cancer in China.

[BACKGROUND] Indocyanine green (ICG) fluorescence imaging-guided laparoscopic lymphadenectomy has been proven to be safe and effective, not only in improving the number of lymph nodes (LNs) but also in prolonging survival in patients with gastric cancer (GC) compared with conventional laparoscopic lymphadenectomy. However, a cost‑effectiveness analysis of this technology has been lacking. This study aims to evaluate the cost-effectiveness of ICG fluorescence imaging-guided laparoscopic lymphadenectomy in GC patients.

[METHODS] Based on FUGES-012 trial, we developed a two-step decision analytic model, including a decision tree model and a partitioned survival model (PSM) with a cycle of 1 month and a 20-year time horizon, to evaluate the cost-effectiveness of ICG fluorescence imaging-guided laparoscopic lymphadenectomy from the perspective of China healthcare system. The primary outcomes included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The economic feasibility of the intervention was determined by comparing the ICER against a willingness-to-pay (WTP) threshold set at 3 times China's 2024 per capita GDP. To assess the robustness of the model results, we conducted one-way deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA). A survival benefit threshold analysis was performed to address the uncertainty in the survival benefit.

[RESULTS] In the base-case analysis, ICG fluorescence imaging-guided laparoscopic lymphadenectomy yielded an ICER of $ 886.30 per additional QALY gained, below the WTP threshold. The DSA reveals that the ICER is most sensitive to discount, cost of progressive disease (PD), additional cost of fluorescence imaging, and utility of progression-free survival (PFS). The PSA demonstrates that ICG fluorescence imaging-guided laparoscopic lymphadenectomy has a probability of 99.30% being cost-effective at WTP. The threshold analysis demonstrated that the cost-effectiveness conclusion is robust to uncertainty in the survival benefit estimate.

[CONCLUSIONS] Compared to conventional laparoscopic lymphadenectomy, ICG fluorescence imaging-guided laparoscopic lymphadenectomy for GC appears to be a cost-effective option in China.